Elimination of dysphagia using ultrasound guidance for botulinum toxin injections in cervical dystonia

Muscle Nerve. 2012 Oct;46(4):535-9. doi: 10.1002/mus.23409.

Abstract

Introduction: Dysphagia is a common side effect after botulinum toxin injections for cervical dystonia, with an incidence of 10-40%, depending upon the study and dose used.

Methods: Our study consisted of 5 preselected women who met criteria for cervical dystonia and subsequent dysphagia after electromyography (EMG)-guided injections. Injections were performed with ultrasound (US) imaging, and the effects on swallowing were examined. Separately, sternocleidomastoid (SCM) thickness in healthy controls and treated patients was measured.

Results: There were 34 episodes of dysphagia over 98 injection sessions using EMG guidance for a cumulative rate of 34.7%. Using US plus EMG guidance, there was 0% dysphagia across 27 injection sessions. SCM thickness was <1.1 cm.

Conclusion: US combined with EMG guidance eliminated recurrent dysphagia after botulinum toxin treatment, possibly by keeping the injectate within the SCM.

MeSH terms

  • Adult
  • Aged
  • Anti-Dyskinesia Agents / administration & dosage
  • Botulinum Toxins / administration & dosage*
  • Deglutition Disorders / diagnostic imaging*
  • Deglutition Disorders / drug therapy*
  • Female
  • Humans
  • Middle Aged
  • Retrospective Studies
  • Torticollis / drug therapy*
  • Ultrasonography, Interventional / methods*

Substances

  • Anti-Dyskinesia Agents
  • Botulinum Toxins